Neurology Flashcards
Symptoms of Charcot - Maries Foot
high arch foot
sharp shooting pain of feet
what infection precedes Gillian barre?
campylobacter jejuni
(gastroenteritis symptoms)
presentation of Gillian barre
reduced reflexes
cranial nerve 7 palsy and diplopia
respiratory muscle weakness
SYMMETRICAL ASCENDING WEAKNESS BEGINS FEET PROGRESSES UPWARDS
4 weeks of trigger
investigation for Gillian barre?
- nerve conduction studies
- lumbar puncture ++protein normal cell count and glucose
DAVID acronym for peripheral neuropath causes?
D - Diabetes
A - alcoholic peripheral neuropathy
V -
management for Guilian barre?
vitamin deficiencies
B12
Infections
shingles
HIV
herpes
types of seizures
tonic clonic
partial focal (focal aware)
myoclonic
focal impaired seizure
tonic seizure
atonic seizure
Diseases - autoimmune
charcot maries
guillian barre
tonic clonic seizure explained?
investigations for seizures
EEG
MRI brain = structural pathology
blood glucose (HbA1c)
U&E = electrolyte imbalance
blood culture
urine dip
lumbar puncture (sepsis, encephalitis or meningitis)
ECG = cardiac syncope
advice for patients?
showers not bath
12 month seizure free before can drive
what is teratogenic in anti epileptics?
sodium valproate
what is given to child bearing patents with seizures?
lamotrigine, levetiracetam
what is given for absent seizures?
ethosuxamide
myoclonic women who are able to have children?
levetiracetam
essential tremor what it is?
fine tremor affecting all voluntary muscles
what is an action tremor?
essential tremor
what tremor is absent at sleep?
essential tremor
when is an essential tremor better?
alcohol
is essential tremor asymmetrical or symmetrical?
symmetrical
location of essential tremor?
hands and head usually
What is MND?
progressive and eventually fatal condition where motor neurones stop functioning
presenting symptoms of MND
usually late middle aged man, increased fatigue of muscles and fatigue after exercise e.g., foot drop
usually first noticed in upper limbs
- trips and clumsiness are first sign
- increased tone and spasticity
- upping plantar reflex
- muscle wasting reduced tone
- reduced reflexes
- slurred speech and dysarthria
(UMN AND LMN SIGNS)
management of essential tremor?
propanolol
what is the second most common MND type?
progressive bulbar palsy
- affects muscle of talking and swelling (most severe)
investigations to diagnose MND
clinical diagnosis made by specialists
what is the management of MND
no cure
Riluzole can slow progression if they have ALS and extend life over months
NIV for respiratory weakness
management for maintaining quality of life.
usually die from respiratory failure and pneumonia
What is the most common type of MND
ALS
multiple sclerosis?
chronic progressive condition where immune system attacks myeline sheath, impacts oligodendrocytes
what other types of MS are there?
secondary progressive (elongated periods of relapse)
primary progressive
(symptoms for a year without disease free period)
most common MS type?
relapsing-remitting
nutrition method preferred for MND?
PEG
symptoms of MS
- optic neuritis (demyelination of optic nerve, unilateral impaired vision, pain moving eyes, colour differences)
- central scatoma - diplopia
- focal weakness (corners, facial nerve palsy, paralysis, incontinence)
- focal sensory numbness
(electric shock sensation on neck flexion) - ataxia
what is lhermittes sign?
electric shock on flexion of neck
if positive = MS
investigations for MS?
- MRI scan to see lesions
- neurologist clinical picture
- lumbar puncture
(oligoclonal bands in lumbar puncture in the CSF)
management for MS?
Flare up treatment: STEROIDS
- high dose oral steroids
- IV steroids 3-5 days if eye involvement
natalizumab ocrelizumab = used to induce long term remission
What is myasthenia gravis
autoimmune condition for muscle weakness
worse activity better at rest
usually women <40 men >60
associated with thymoma
- motor neurone communicate with neuromuscular junction.
ACH antibodies are produced and block the AcH receptors
most common antibodies to be seen in myasthenia graves?
ACh receptor antibodies
- Muscle specific Kinase (MUSK)
- LRP4 (low density lipoprotein)
presenting symptoms of Myasthenia Gravis?
- eyelid weakness (drooping eyelid)
- double vision
- worsening with activities
- climbing stairs, raising hands up head
- jaw fatigue and swallowing issue
- weakness in facial movements and slurred speech?
investigations of myasthenia gravis
blood AcH, MuSK and LRP4
CT or MRI thymoma
management for myasthenia gravis
pyridostigmine is mangat treatment for myasthenia graves
prednisolone for immunosuppression
thymectomy
rituximab
what is parkinson’s disease
reduction of dopamine from basal ganglia
3 and more cardinal symptoms of Parkinson’s
- resting tremor (unilateral) - pill rolling, worse when distracted
2.cogwheel rigidity - bradykinesia (slowing of movements)
- stoop posture
5.lack of arm swing - shuffling gait
- hypomania (no facial expression)
parkinson + sydromes?
4 main ones
- multi system atrophy
- dementia with lewy bodies (dementia with parkinsonian features, visual hallucinations, fluctuating consciousness)
- progressive supranuclear palsy
- cortical basal degeneration
management for Parkinson’s
refer to neurologist and give levodopa
co-beneldopa (peripheral decarboxylase inhibitor) given to prevent breakdown
MOAI (selegiline) prevent breakdown
COMT (entcapone) prevent breakdown
Cabergoline (dopamine agonist)
cabergoline can develop into what?
pulmonary fibrosis
what will spinal cord injury present with?
- motor symptoms
- weakness or paralysis
- UMN signs - sensory symptoms
- shock burning
- loss or alteration - Pain
- neuropathic - autonomic
- HTN and bradycardia
- bladder and bowel dysfunction (IF BELOW T11/12)
- Sexual dysfunction
anterior cord syndrome
loss of motor and pain/temp
preserved proprioception
anterior spinal artery occlusion
investigations for since cord injury?
CT spine
MRI for soft tissue
central cord syndrome ?
impacts the upper>lower
usually elderly patients with hyperextension injuries of neck
brown squared syndrome?
usually penetrating trauma
-ipsilateral motor function loss
-contralateral temp and pain loss
subarachnoid haemorrhage presentation ?
usually ruptured cerebral aneurysm in the brain
between pia and arachnoid membrane
- thunder clap headache which reaches max intensity 30s-1min
- usually in sex or heavy lifting
- neck stiffness, vomiting and photophobia
- visual changes, dyshagia and lack of consciousness, week of headaches
LACK OF FEVER = NO MENINGITIS
management of spinal cord lesions
IV methylprednisolone
surgical decompression or referral
risk factors for subarachnoid haemorrhage
family history
PCOS
HTN
Smoking
Excessive alcohol
cocaine use
sickle cells
investigations for subarachnoid haemorrhage?
CT head first line WITHIN 6 HOURS OF SYMPTOMS ONSET
lumbar puncture otherwise = look for yellow colour (xanthochromia , increased bilirubin)
ECG
CT angio to locate
medical management for subarachnoid haemorrhage
Nimodipine used to prevent vasospasm which cause brain ischaemia
subdural haemorrhage cause?
shearing of bridging vein - whiplash
high impact injuries
surgical management for subarachnoid
coiling
investigation for subdural haemorrhage?
CT scan show crescent shape
management of subdural haemorrhage
where does bleeding present on CT in subarachnoid?
ventricles and cystines (middle of brain)
extradural haemorrhage causes?
middle meningeal in temporparietal region
biconvex CT scan what is it?
extradural
what is subarachnoid?
rupture of aneurysm
dilated pupil is indicated of what haemorrhage
extradural haemorrhage
trigeminal neuralgia impacts what nerve?
what triggers trigemnial neuralgia what is the cause?
pinprick sharp feelings over the face
small muscle movements usually cause pain (washing, shaving, smoking, talking)
unilateral
management for trigeminal neuralgia?
carbamazepine
failure to respond then referral
